Home in On the Details in 2018 Ob-gyn Coding

Tue, Nov 21, 2017


Most ob-gyn coders know the mantra—specificity, specificity, specificity. If you want prompt and ethical reimbursement in 2018, though, specificity just got real. Are you up to date on the changes now in effect?

Pick a Side with New Sixth Character for Tubal and Ovarian Pregnancies

CMS provided some much-needed updates to tubal and ovarian pregnancies with and without intrauterine pregnancy. Lateral status, historically absent in the code description, is now indicated in a new sixth character:

Deletion of O00.10 (Tubal pregnancy without intrauterine pregnancy)

  • Addition of O00.101 (Right tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.102 (Left tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.109 (<...
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Medicare Open Enrollment: What’s New for 2018?

Tue, Nov 14, 2017


It’s that time of year again — time for your patients to start thinking about their healthcare needs and what they’re looking for in their Medicare health and drug plans. Medicare Open Enrollment began on Oct. 15 and will remain open until Dec. 7. And there’s good news. CMS reports more options and lower premiums in 2018, which means your patients should be able to find plans that cost them less and give them more.

This year’s lineup includes the addition of 400 Medicare Advantage plans from which your patients can choose, with greater than 85 percent of Medicare recipients having access to ten or more Advantage plans. Monthly premiums for the average Medicare Advantage will decrease by almost $2.00, reducing the average cost by about 6 …

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5 Fast Facts About 1 Payer’s 50 Percent Fee Reduction for Modifier 25

Mon, Nov 6, 2017


50 percent pay cut

A payer’s big modifier 25 payment reduction has been getting a lot of attention, both from providers affected and those concerned other payers will adopt the policy. Don’t miss this overview of what the policy is all about.

1. Which Payer Implemented the Policy?

Independence Blue Cross, which primarily serves Philadelphia and southeastern Pennsylvania, updated its commercial policy and Medicare Advantage policy related to modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service).

2. When Is the Policy Effective?

The policy changes went into effect …

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‘Hoo’ Is Performing Photodynamic Therapy? CPT® 2018 Says You’d Better Know

Tue, Oct 31, 2017


Happy Halloween!

Hope you can forgive that bit of Halloween headline fun before we get down to serious coding business! Maybe “‘Witch’ Team Member” would have been more to your liking than “Hoo.” Either way, I bet you are ready for more CPT® 2018 news now. Here’s what you need to know about the photodynamic therapy update swooping our way Jan. 1.

The procedure: Photodynamic therapy services involve using a photosensitive agent at one or more target areas and then applying a special light to activate the agent. The activation by the light results in a special kind of oxygen that destroys certain cells.  An example service would be removal of a lesion from an eyelid.

Kick Things Off With …

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INR Monitoring Code Changes Coming (But Old Faves Could Stick Around, Too)

Thu, Oct 19, 2017


patient training

If you code for anticoagulant management — and a lot of folks do — you’ll need to get a handle on some changes headed our way when CPT® 2018 is effective on Jan. 1, 2018. Here’s the scoop.

Let’s Start With What’s In and What’s Out for CPT®

Out: In CPT® 2018, these two codes will be deleted:

  • 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements))
  • 99364 (… each subsequent 90 days …
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For World Anesthesia Day, Here’s What’s New in CPT® 2018 for 00000-Range Codes

Fri, Oct 13, 2017


CPT 2018 changes for anesthesia

October 16 is World Anesthesia Day because the first successful demonstration of ether anesthesia occurred on that date in 1846. Boston dentist William Morton administered the ether to a patient undergoing removal of a neck tumor. Mark me down in the glad-anesthesia-is-available column.

In honor of World Anesthesia Day on Monday, let’s look at what’s new for anesthesia in CPT® 2018. If you code anesthesia for GI procedures, neurectomy, or shoulder cast application, there’s some news you need to know.

Get Ready for These GI Changes

In 2017, you …

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Observe National Breast Cancer Awareness Month With Increased Neoplasm Coding Know-How

Mon, Oct 9, 2017


ICD-10 coding for breast cancer

October is National Breast Cancer Awareness Month. You may be familiar with the statistic that roughly one in eight women will develop invasive breast cancer. For men, the lifetime risk is about 1 in 1,000.

The expansion of male breast cancer diagnosis codes to be as specific to site as female breast cancer codes was one of the important changes oncology coders had to learn back when ICD-9 changed to ICD-10. Here are some documentation tips to help with breast cancer coding and a bonus tip on ICD-10-CM 2018 changes to breast lump coding.

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Get the Big Picture With CPT® 2018 Radiology Deletions and Revisions

Wed, Oct 4, 2017


CPT 2018 changes to chest X-ray codes

We’ve already talked about new CPT® 2018 codes in an overview (Part 1 and Part 2) and a more specific path/lab post. Now let’s start digging in a little more. Today we’ll look at some of the radiology chapter revisions and deletions related to code additions in CPT® 2018, which is effective on Jan. 1, 2018.

Learn a New Way to Code Chest X-Rays

If you use fluoroscopy code 76000, …

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What Does ICD-10 Have to Do With Prescriptions to Treat Acute Pain?

Wed, Sep 27, 2017


We’re just days away from ICD-10 2018 implementation. One group with ICD-10-CM on the brain may be Ohio pharmacists.

Here’s why: Effective Dec. 29, 2017, there will be new rules in Ohio for prescribing opioids. One of the requirements is for the prescription to include “The ICD-10-CM medical diagnosis code of the primary disease or condition that the controlled substance is being used to treat.” The code is one more step in proving the prescription is for a legitimate medical purpose.

Know That 4 Characters Is OK

Interestingly, the code included on the prescription needs to provide only the first four characters …

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Straight From the Source: Use Modifier 25 the Right Way With CCI Manual Tips

Fri, Sep 22, 2017


It can be tricky knowing when to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

More specifically it can be tough to determine whether work performed by a provider amounts to a separate E/M (reportable with modifier 25) on the same DOS as another procedure. And the consequences are big. Just ask the eye institute whose modifier 25 use resulted in a $113, 722.10 settlement with the government.

Helpful hint: The National Correct Coding Initiative Policy Manual for Medicare Services (aka CCI manual) offers …

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